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Therapeutics Exam 2 > Abx Dickey > Flashcards

Abx Dickey Flashcards

0
Q

Describe molds

A

Multi-cellular
Reproduce by disseminating spores
Mainly cause invasive dz through inhalation
-pulmonary dz most common, but can disseminate

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1
Q

Describe yeasts

A

Single-celled
Reproduce by budding
Cause superficial or invasive infections

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2
Q

Describe dimorphic yeasts

A

Exist as either a yeast or mold, depending on pathogen, site of growth (host vs. lab), and temperature

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3
Q

Give examples of yeasts

A

Candida

Cryptococcus

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4
Q

Give examples of dimorphic fungi

A

Histoplasma

Blastomyces

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5
Q

Give an example of a mold

A

Aspergillus

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6
Q

Which type of fungi is classified one way but acts another?

A

Cryptococcus is classified as primary (pathogenic), but acts more opportunistic

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7
Q

List pathogenic fungi

A

Histoplasmosis
Blastomycosis
Cryptococcus

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8
Q

List opportunistic fungi

A

Candidiasis
Aspergillosis
(Cryptococcus acts opportunistic)

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9
Q

Fungi that may cause dz in both healthy and immunocompromised individuals

A

Primary (pathogenic) fungi

Histoplasmosis, blastomycosis, and cryptococcosis*

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10
Q

Fungi that generally cause dz in immunocompromised individuals

A

Opportunistic

Candidiasis, aspergillosis, Cryptococcus*

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11
Q

Types of pts who are immunocompromised:

A 
Diabetes
Lymphoreticular/hematologic malignancies
Immunodeficiency dz (eg: HIV)
Immunosuppressive Therapy
 -High dose corticosteroids
 -Immunosuppressants
 -Antineoplastic agents
 -Broad spectrum Abx
Organ transplants
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12
Q

C. Albicans

A

50% of candida species
Most virulent
SUSCEPTIBLE to azoles

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13
Q

Candidiasis is usually acquired via

A

GI tract

May enter bloodstream via indwelling IV catheter

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14
Q

Risk factors for candidemia

A 
Multiple Abx
Vascular access
Parenteral nutrition
ICU stay > 7 days
Candida colonization 
Renal failure
Major abdominal surgery
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15
Q

Tx of chronic disseminated candidiasis

A 
Fluconazole or
Ampho B (for several weeks followed by transition to fluconazole)
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16
Q

Tx of candidiasis in neutropenic adults

A

Echinocandin or

Lipid formulation of Ampho B

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17
Q

Tx of candidiasis in nonneutropenic adults

A

Fluconazole or

Echinocandin

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18
Q

All pts with candidemia need…

A

An eye exam to rule out Candida endophthalmitis

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19
Q

Treatment duration for candida infxns

A

14 days after 1st negative culture and signs of clinical improvement

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20
Q

Empiric therapy for candida infxns should be initiated…

A

Within 4 days or persistent fever unresponsive to Abx; possibly sooner in pts with risk factors present

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21
Q

Name two species of Cryptococcus

A

C. neoformans

C. gattii

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22
Q

Where does Cryptococcus exist

A

In soil and pigeon droppings worldwide

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23
Q

How is Cryptococcus infxn acquired?

A

Through inhalation of the organism

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24
Q

What is the 2nd most common fungal pathogen

A

Cryptococcus

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25
Q

Primary Cryptococcosis in humans almost always occurs…

A

In the lungs

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26
Q

Two most common candidiasis species and their susceptibilities:

A

C. albicans - S to azoles, Echinocandin, & amphoB

C. glabrata - use Echinocandin, R to azoles

27
Q

Cryptococcus disseminates into…

A

CSF - meningitis

28
Q

Tx of Cryptococcus infxn, pulmonary, asymptomatic

A

Drug tx usually not req’d
Observe
or fluconazole

29
Q

Tx of Cryptococcus infxn, pulmonary, mild-mod

A

Fluconazole

30
Q

Tx of Cryptococcus infxn, pulmonary, severe or inability to take azoles…

A

Ampho B

31
Q

Tx of Cryptococcus infxn, CNS, HIV or transplant pt…

A

3 stages

  1. Induction - Ampho B plus Flucytosine (more Ampho if renal dysfx or inability to take Flucytosine)
  2. Consolidation - fluconazole
  3. Maint. - fluconazole
32
Q

Tx of Aspergillus infxn…

A

Voriconazole

33
Q

Prophylaxis for Aspergillus infxn…

A

Posaconazole

34
Q

Tx of mild-mod histo, pulmonary…

A

If symptoms >4 wks: itraconazole

35
Q

Tx of mild-mod histo, disseminated…

A

Itraconazole

36
Q

Tx of mod-severe and CNS histo, (both pulm and disseminated)…

A

Ampho B followed by itraconazole

37
Q

Tx of chronic cavitary pulmonary histo…

A

Itraconazole

38
Q

Tx of mild to mod Blastomyces infxn…

A

Itraconazole

39
Q

Tx of mod-severe Blastomyces infxn…

A

Ampho B followed by itraconazole

40
Q

Presence of viable microorganisms in the blood by a positive culture result is known as…

A

BSI

41
Q

Difference between primary and secondary BSI

A

Primary - no known cause

Secondary - secondary to a localized focus of infxn

42
Q

Examples of secondary BSI causes

A

Biliary Tract Infxn
Wound Infxn
Skin / ST Infxn
Pneumonia

43
Q

List usual contaminants of BSIs…

A

Coag Neg Staph
Bacillus
Corynebacterium
Propionibacterium

44
Q

List important Gram (+) clinical pathogens in BSIs…

A

S. aureus
Strep. pn
Group A Strep

45
Q

List important Gram (-) clinical pathogens in BSIs…

A 
Enterobacteriaceae
Haemophils 
Pseudomonas aeruginosa 
Bacteroides species
Candida species
46
Q

Gram pos. clusters, think…

A

Staph

47
Q

Gram pos. pairs/chains, think…

A

Strep or

Enterococci

48
Q

Empiric tx for gram (+) BSI…

A

Vancomycin

-cidal

49
Q

Which organisms are more likely to disseminate more than others?

A

Gram pos. cocci = Candida&raquo_space;> Gram neg. rods

50
Q

Tx for MSSA BSI…

A

Nafcillin, oxacillin, or cefazolin

- Vanc ok if beta-lactam allergy

51
Q

Tx of MRSA BSI…

A

Continue Vanc.

-Daptomycin preferred if MIC > 2

52
Q

Tx of Enterococcus BSI…

A

Ampicillin

- Vanc. ok if beta-lactam allergy

53
Q

Tx of Enterococcus- VRE BSI…

A

Daptomycin

54
Q

Tx of Streptococcus BSI…

A

Beta-lactam

- Vanc. ok if beta-lactam allergy

55
Q

Most frequent bacteria in inpatient BSIs…

A 
S. aureus
E. coli
Enterococcus 
CoNS
P. aeruginosa
56
Q

Most frequent bacteria in outpatient BSIs…

A 
E. coli
S. aureus
Enterococcus 
P. aeruginosa
CoNS
57
Q

Non-pharm tx of Gram (+) BSI…

A

Follow up TTE/TEE - see if endocarditis is present

Remove central venous catheter

58
Q

Which type of BSI should you check for pseudomonas?

A

Gram Neg BSI

59
Q

Pseudomonas RFs…

A 
Severe sepsis or septic shock present
Immunocompromised
ICU
Recent pseudomonas infxn 
Recent hospitalization
Long-term hemodialysis 
Nursing home
Recent IV Abx
Recent chemotherapy
60
Q

Tx of Gram Neg. BSI if pseudomonas suspected…

A

Two drugs with two different MOAs:

  1. cell wall agents
    • piper/tazo -aztreonam
    • ticar/clavu -meropenem
    • ceftazidime -imipenem/cilastin
    • cefepime -doripenem
  2. Aminoglycosides
    • gent, tobra, or amikacin
  3. FQLs
    • cipro or levofloxacin
61
Q

Tx of ESBL BSI…

A

Empiric tx with Carbapenems

  • imipenem/cilastin
  • meropenem
  • doripenem
  • ertapenem
62
Q

Tx of Gram Neg. BSI when suspecting pseudomonas and ESBL…

A

Carbapenem (for ESBL) PLUS either
-aminoglycoside or
-FQL
(2 drugs - 2 MOAs for pseudomonas)

63
Q

ESBL RFs…

A

Previous ESBL infxn
ICU
Failure to improve on other BS Abx
Previous hospitalization w/in last 3 months
Exposure to cephs, carbs, or FQLs w/in 30 days
Extensive hospital or ICU stay
Recurrent UTIs
Chronic catheter
Hemodialysis
Urosepsis based on local sensitivities for ESBLs

64
Q

Non-pharm tx for Gram (-) BSIs…

A

Remove central venous catheters

65
Q

Tx DUR for all BSIs…

A

14 days after neg. culture & signs of improvement

- maybe shorter for enterococcus

Therapeutics Exam 2 (15 decks)

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